Healthcare Provider Details

I. General information

NPI: 1487418042
Provider Name (Legal Business Name): JENNIFER AKUNNA IHEDIOHA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 UNION SQ W FL 7
NEW YORK NY
10003-3304
US

IV. Provider business mailing address

19 UNION SQ W FL 7
NEW YORK NY
10003-3304
US

V. Phone/Fax

Practice location:
  • Phone: 212-627-9600
  • Fax: 718-797-1115
Mailing address:
  • Phone: 212-627-9600
  • Fax: 718-797-1115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number407206
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: